What Is Dupuytren's Contracture?

Have you noticed a small lump in the palm of your hand that has slowly started to thicken and pull your fingers inward? This could be a sign of Dupuytren's contracture, a hand deformity that typically develops over several years. While it's usually painless, the condition can significantly impact your ability to perform daily tasks, such as washing your hands, wearing gloves, or shaking hands with someone.

This guide will explain what Dupuytren's contracture is, what causes it, and how it progresses. We'll also cover the available treatment options to help you understand how to manage the condition and when it might be time to see a specialist. Understanding the progression of this condition is the first step toward regaining function and improving your quality of life.

Understanding Dupuytren's Contracture

Dupuytren's contracture is a condition that affects the layer of tissue, called the palmar fascia, that lies just under the skin of your palm. Over time, this tissue thickens and forms knots. These knots can eventually create a thick cord that pulls one or more of your fingers into a bent position.

This condition most commonly affects the ring and pinky fingers. While it can occur in both hands, one hand is usually more severely affected than the other. The primary issue with Dupuytren's is not pain, but the loss of function. As the fingers curl inward, simple activities that require a flat hand become difficult or impossible.

What Causes It?

The exact cause of Dupuytren's contracture is unknown, but researchers have identified several risk factors that increase the likelihood of developing the condition. It is not caused by an injury or overuse of the hands.

Key risk factors include:

Genetics: The condition often runs in families, suggesting a strong genetic link. It is particularly common in people of Northern European (English, Irish, Scottish, French, Dutch) and Scandinavian (Swedish, Norwegian, Finnish) descent.
Age: The risk of developing Dupuytren's contracture increases with age, most commonly appearing after the age of 50.
Sex: Men are more likely to develop the condition than women and tend to have more severe contractures.
Medical Conditions: Certain medical conditions are associated with a higher risk, including diabetes, seizure disorders (epilepsy), and alcoholism.
Tobacco Use: Smoking is also linked to an increased risk, possibly due to microscopic changes it causes in the blood vessels.

The Stages of Dupuytren's Contracture

Dupuytren's contracture progresses slowly and predictably through several stages. The rate of progression can vary significantly from person to person.

Stage 1: Nodules

The first sign is usually the appearance of one or more small, firm lumps or nodules in the palm of your hand. These nodules are often painless but may be tender to the touch initially. At this stage, there is no contracture, and hand function is not typically affected. Many people first notice these lumps when they place their hand flat on a surface.

Stage 2: Cords

Over time, these nodules may thicken and form rope-like cords of tissue that extend from the palm into the fingers. These cords are visible under the skin and feel firm. As the cords develop, they begin to tighten, but the fingers are not yet pulled into a bent position. Hand function remains largely intact during this stage.

Stage 3: Contracture

This is the stage where the condition becomes more problematic. The cords continue to tighten and shorten, pulling the affected fingers down toward the palm. This bending is called a contracture. Initially, the contracture may be mild, but it can worsen over time, making it impossible to straighten the fingers completely. The "tabletop test" is a simple way to check for this stage: if you can't lay your hand flat on a table, you likely have a contracture.

Stage 4: Severe Contracture

In the most advanced stage, the contracture becomes severe, and the fingers are pulled tightly into the palm. This can lead to significant functional limitations, interfering with daily activities like gripping objects, putting on gloves, or even washing your face. In some cases, the skin can become macerated in the deep folds, leading to hygiene issues.

Treatment Options for Dupuytren's Contracture

While there is no cure for Dupuytren's contracture, several treatment options can help manage the symptoms and improve hand function. Treatment is generally not needed during the early stages (nodules and cords) unless there is pain. The primary goal of treatment is to straighten the affected fingers and restore function.

Nonsurgical Treatments

For mild to moderate cases, nonsurgical options may be considered.

Enzyme Injections: This procedure involves injecting an enzyme (collagenase) directly into the cord. The enzyme works to dissolve the tough tissue, and about 24 to 72 hours later, your doctor will manipulate the finger to break the cord and straighten it.
Needle Aponeurotomy: In this minimally invasive procedure, a doctor uses the tip of a hypodermic needle to puncture and break apart the cord of tissue. This is done under local anesthesia in an office setting.

Both procedures offer quicker recovery than surgery but may have a higher rate of recurrence.

Surgical Treatments

For more advanced contractures, surgery may be the most effective option. An orthopedic surgeon can perform procedures to remove the thickened tissue and release the contracture.

Fasciotomy: The surgeon makes an incision in the palm and divides the thickened cord of tissue.
Subtotal Palmar Fasciectomy: This is the most common surgery for Dupuytren's. The surgeon removes as much of the abnormal tissue and cords as possible to allow the finger to straighten.

Recovery from surgery can take several weeks or months and often involves hand therapy to regain strength and movement. Your orthopedic surgeon will help you decide which treatment is best based on the severity of your condition and your lifestyle.

When to Seek Help

It's a good idea to consult a doctor if you notice any nodules or cords in your palm, even if your hand function isn't yet affected. An early diagnosis can help you and your doctor monitor the condition's progression.

You should definitely seek treatment if the contracture starts to interfere with your daily life. If you can no longer place your hand flat on a table, it’s a strong sign that it’s time to discuss treatment options. An experienced orthopedic surgeon can provide a thorough evaluation and recommend a personalized treatment plan.

Your Path to Better Hand Function

Dupuytren's contracture can be a challenging condition, but understanding its progression and the available treatments is the first step toward managing it effectively. With the right care, you can restore hand function and maintain your quality of life.

If you are experiencing symptoms and looking for an orthopedic surgeon in Orange City, FL, our team is here to help. Contact the Central Florida Bone & Joint Institute today to schedule a consultation and learn more about your treatment options.